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What's Delaying Digital Health Records?

The director of the U.S. Office of Health IT Adoption explains why it’s so hard to get doctors to go digital.

The average baby boomer with multiple health concerns likely has a slew of doctors–a primary-care physician to manage day-to-day issues, a cardiologist to monitor a blocked artery, a rheumatologist to manage arthritis pain, and an orthopedist to treat a trick knee. But chances are that these physicians aren’t in regular contact and that the patient’s fragmented medical records are isolated in different databases and paper files.

Digitizing health care: Karen Bell, director of the Office of Health IT Adoption at the U.S. Department of Health and Human Services.

That problem could be solved, or at least drastically reduced, by electronic health records, which allow data to be easily shared among physicians, pharmacies, and hospitals. Such systems help coordinate a patient’s care, eliminating duplicate testing and conflicting prescriptions, and ultimately cutting costs.

But despite the benefits, only 15 to 18 percent of U.S. physicians have adopted electronic health records. Karen Bell, director of the Office of Health IT Adoption at the U.S. Department of Health and Human Services, spoke with Technology Review’s biomedical editor Emily Singer about the hurdles to digitizing health care.

Technology Review: What have been the biggest hurdles in getting physicians to adopt electronic health-care records?

Karen Bell: We still lack a compelling business case in terms of purchasing, upkeep, and decreased productivity. Physicians have to shell out considerable upfront costs and lose about 20 percent productivity in the first few months as personnel get used to the system. And the average primary-care physician doesn’t have time to research different systems and learn how to use them: every minute they are not seeing patients, they are not getting paid.

The places you do see high rates of adoption are large physician groups. Thirty percent of those have already established electronic health records. That’s because the group can negotiate a great price and can provide lots of support.

TR: Who has done this well?

KB: Denmark. They gave physicians a choice of electronic health-record systems at reasonable cost and then provided extensive consulting services. They also established a pay differential, so that physicians who adopted EHRs were paid more.

TR:Have the health-care systems that have adopted electronic record-keeping seen beneficial changes?

KB: The Rand Corporation has looked at Kaiser, Partners, and other large systems. You certainly see that they perform better on quality-of-care measures [such as whether patients with uncontrolled high cholesterol are prescribed statins]. But we don’t know how that will translate into small offices. And because there is no standard way to calculate cost savings, it is hard to measure returns. We all believe that benefit is there; we just have to find a way to measure it.

TR: What about the public-health benefits? Systems that house large quantities of patient data could enable new types of research studies.

KB: Absolutely, that’s something I get really excited about. It will totally break open our knowledge base. For example, I have been diagnosed with low-pressure glaucoma, which is fairly unusual. No one knows what causes it. I would love to be able to search the system for anyone with this form of glaucoma and start to look for similarities.

TR:When do you think that kind of study would be possible?

KB: We would need large numbers of people with patient-controlled health records, but the numbers are still very low. The number [of practices] with fully functional electronic health records–meaning information can be easily shared between systems–is only about 4 percent.

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